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Long-term blood pressure variability and risk of cardiovascular disease events among community-dwelling elderly


Ernst, ME and Chowdhury, EK and Beilin, LJ and Margolis, KL and Nelson, MR and Wolfe, R and Tonkin, AM and Ryan, J and Woods, RL and McNeil, JJ and Reid, CM, for the ASPREE Investigator Group, Long-term blood pressure variability and risk of cardiovascular disease events among community-dwelling elderly, Hypertension, 76, (6) pp. 1945-1952. ISSN 0194-911X (2020) [Refereed Article]

Copyright Statement

Copyright 2020 American Heart Association, Inc.

DOI: doi:10.1161/HYPERTENSIONAHA.120.16209


High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, cardiovascular disease, hypertension, intrinsic factors, risk factors
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Health related to ageing
UTAS Author:Nelson, MR (Professor Mark Nelson)
ID Code:142078
Year Published:2020
Web of Science® Times Cited:11
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-12-10
Last Modified:2022-08-25

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